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Comment by PaulDavisThe1st | Hacker News Reader

It is deeply frustrating to me that there doesn't even seem to be agreement on basic facts about sars-cov-2/covid19 yet. Death rate? They're still arguing. Risk of serious complications by age group or complications? Still arguing. Negative impacts of social distancing/lockdown measures? Still arguing.

I think it's great that there is an argument about this, but it still feels disappointing that it will still clearly take a lot longer then 10 months to clarify these points to a level where no serious high level medical professional disagrees.

In the meantime, I'd also appreciate it if we could get back to a lot more talk of "flatten the curve" in our public discourse. Nobody seems to seriously doubt that at some point almost all humans will be exposed to the virus. The question is how rapidly that happens, and the concomittant impact on health care and the economy if it happens too fast.

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I've been reading about this virus daily since February and my impression has been the opposite. It's a very boring virus which has offered very few surprises. We knew since February that it is a flu-like respiratory disease with high rates of hospitalization and death, especially among the old. The initial estimates for fatality rate were about 4% and that has now been narrowed to 1% based on better testing and treatment. Social distancing and masks are effective at controlling the spread. All of this has been known since February/March, most of it is spelled out here: https://www.who.int/docs/default-source/coronaviruse/who-chi...

At the same time, there has been an endless parade of contrarians trying to make the whole thing into a big mystery and muddy the waters for some reason. There was the theory that the virus was spreading much earlier than expected. There was the theory that most cases were asymptomatic and that immunity had already been reached. The theory that lockdowns are not effective. The theory that there were different strains with highly different behavior. Some vague theory about t-cell immunity.

None of these contrarian theories have been supported by any real evidence, but there is a large appetite for them and people will seize on any puzzling number to try to rethink the whole picture of the virus.

This doesn't align with my tracking of virus facts.

1) the death rate is still unclear because very few localities have done sufficient and/or the right kind of testing to answer this in a definitive way.

2) initial estimates about hospitalization across age cohorts seem to have turned out to be fairly far off. Tracking the stats for my own state (New Mexico; admittedly a fairly small population), we sometimes have almost flat hospitalization rates across age cohorts.

That report was dated 16-24 February 2020. It was authoritative at the time of writing (hard not to be given the limited breakouts outside of Wuhan at that time), and the reporting on the physical structure and mechanisms of the virus have remained largely unchanged AFAIK.

But the epidemiological aspects of covid19 have, I think, changed quite a bit since that report. The report doesn't in fact coe down strongly in favor of masks:

"The relative importance of non-pharmaceutical control measures including masks, hand hygiene, and social distancing require further research to quantify their impact."

and in the section titled "Knowledge Gaps" includes "Effectiveness of the public health control measures and their socio-economic impact ... * Wearing mask in general public", along with most "lockdown" type policies.

1) I'm not a researcher and I can't claim to have a comprehensive view of the evidence, but I think there have been enough high-quality studies based on seroprevalence to give a good estimate. This one https://www.medrxiv.org/content/10.1101/2020.08.06.20169722v... found an IFR of 0.83% in spain, or 1.07% if counting excess deaths. This one https://www.medrxiv.org/content/10.1101/2020.06.27.20141689v... found an estimate of 1.39% in NYC. The WHO has estimated 0.6%. These studies are based on representative antibody surveys with good statistical power, they should be accurate. There are factors like demographics and comorbidities that can push the number much higher or lower in a given community, but the range does not seem that wide to me.

2) I haven't been tracking hospitalization data very closely, you may be right that this has changed ... I've seen little discussion of it.

I agree that mask use in particular was controversial for a rather long time, with bodies like the CDC seemingly dragging their feet on recommending the use of masks. Still, I think that it's been a pretty settled question since April (CDC recommended masks from April 3 https://www.livescience.com/cdc-recommends-face-masks-corona...).

I would agree with you that it does look as if the overall IFR is in the range of 0.8-1.6%, and that the Spanish study was well conducted. But it is also horrifying that a pandemic that has killed more than 1M people worldwide still has so few similar studies to help answer these questions.

2. I don't want to make strong claims about this, but I do think it has moved quite a bit.

3. Yes, mask utility seems really well established now and has been for "many" months.

I still wish we would hear more public speakers using the numbers from 1. above combined with "flattening the curve" to make it clear what we're trying to do. 1% of the US is a million people. That could still be the outcome, but at the very least, we'd like that not happen all in the same month!

We now know that antibody seroprevalence studies missed many of the mild cases. This is naturally difficult to quantify.

https://www.bmj.com/content/370/bmj.m3364

So the actual IFR is probably lower than the numbers you cited.

If you look at the responses to that editorial, they note that the 11% positivity of igA tests, cited as suggestive of a high level of undetected infection, is actually the false positive rate of the test, among other embarrassing errors.

The first citation on your linked editorial is Ioannidis, which is the same Stanford researcher in the OP article here, and the same group responsible for the utterly flawed Santa Clara study. It seems like it's literally this one group, and a few other weirdos and contrarians, singlehandedly raising spurious doubts about the science, and then being amplified beyond all reason.

The cited Ioannidis study also sucks, he takes a number of seroprevalence studies, including some very flawed or underpowered ones, and then takes the unweighted median for some reason? More details here, including an illustration of how the high-quality, randomly-selected samples do not vary so much https://twitter.com/GidMK/status/1283232023402868737

You're missing a big part of the picture. It is well established that some patients infected with SARS-CoV-2 either never produce detectible levels of antibodies, or have them fade away quickly. In order to measure actual infection numbers we need to look beyond antibody seroprevalence, and factor in CD4+ and CD8+ T cell assays as well.

https://doi.org/10.1016/j.cell.2020.08.017

90% of PCR-positive subjects in the ENE-COVID test, for example, did also have a positive antibody test. So actual infection numbers might be ~10% higher than the raw numbers from the antibody tests (and I believe that this is factored into the results reported by such studies). It doesn't change our big-picture understanding of the disease.

T cell immunity is hardly vague. There have been multiple peer-reviewed journal articles published on that topic.

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C24&q=mem...

I think the death rate in particular has been the victim of politics. Each side has in interest in presenting it as higher or lower, particularly relative to the flu. The true value is unknowable as it requires perfect test data. And the available data (case fatality rate) is rejected by the "it's just the flu" camp, because they say the true denominator is much higher.

But honestly, who cares about the actual number? The flu death rate is subject to the same problems. Nobody gets tested for asymptomatic flu. We're should be comparing the CFR for flu to the CFR for COVID, and this shouldn't be an argument.... But it is.

Indeed, which is why I consider excess mortality numbers to be the most useful numbers on death rate that we have, although I have still not found an excellent breakdown on what they show (notably by age cohort).

But excess mortality can be changed by behavior. That's part of the point of lockdowns. You can't know the hypothetical death rate given no lockdown measures.

The people who are arguing are the people who are politicizing the normal scientific process of drawing conclusions from available evidence.

>Death rate? They're still arguing.

Trouble is it isn't a fixed number. It depends who the people are, what treatment is available and so on. It's come down over time for various reasons. These things aren't as simple as they might be.

I agree with your sentiment. It really shows that COVID-19 has been politicised so much that people can't debate on the topic anymore in good faith, because nobody wants to admit that they might have been wrong. Especially people like Donald Trump make a scientific debate extremely difficult, because he has been undermining the virus from the beginning and even if science was to find that the virus was less dangerous than initially thought many scientists, especially those who had public exposure, wouldn't want to support/admit an idea which could play into Trump's favour. The whole thing is just a bloody mess.

> Nobody seems to seriously doubt that at some point almost all humans will be exposed to the virus.

Unfortunately there are many people who really believe we can eliminate the virus through strict measures. Just read many responses here on Hacker News and you'll find plenty of those people.

This rings true. As soon as it was politicized neither side will budge an inch. And scientific progress requires people being able to admit they were wrong in the face of new evidence. Egos should not be wrapped up in how many feet at which social distancing is effective and how effective masks are and when lockdowns should be enforced or let up. Its really unfortunate and, in my opinion, goes to show the two party system is bad for democracy, science, progress, etc. We need more polictical parties and ranked choice voting, and less blind following of one's parties ideals/agenda/candidates.

> because he has been undermining the virus from the beginning

No, he wasn't. Where did you get that idea? https://www.nytimes.com/2020/01/31/business/china-travel-cor...

January 22nd, 2020:

Asked if his administration was worried about a coronavirus pandemic, Trump says, “No, we’re not at all. And we have it totally under control. It’s one person coming in from China.”

https://www.cnbc.com/2020/01/22/trump-on-coronavirus-from-ch...

January 30th:

The World Health Organization declares the coronavirus a “public health emergency of international concern.” • At an event in Michigan, Trump says, “We’re working very strongly with China on the coronavirus—that’s a new thing that a lot of people are talking about….We think it’s going to have a very good ending for it. So that I can assure you.”

https://www.whitehouse.gov/briefings-statements/remarks-pres...

Now, I will grant you that he established the task force on Jan 29th, but against that I will note that the "China travel ban" did not prevent Americans who had been in Wuhan and other affected areas from returning to the US. I would also add the person chosen to head the task force at the start, secretary of HHS, Alex Azar, on August 23rd (after all we know now) explained things this way:

> Alex M. Azar II, the secretary of health and human services, defended members of President Trump’s family on Friday for refusing to wear masks at the recent presidential debate despite a requirement that the audience do so. The first family and the president are “in a different situation than the rest of us,” Mr. Azar said, because they are in a protective bubble."

https://www.nytimes.com/live/2020/10/02/world/covid-19-coron...

I think it's fair to say that Trump's actions along with his then-private conversations with Woodward, can be reasonably (if incompletely) summarized by saying that he has tried to downplay the virus from the start.

And that's the problem with... let's say politics generally, but Trump especially. Two of Trump's biggest winning issues have been travel bans and China. Taking the opportunity to combine them was such a political no-brainer that he didn't need to believe in the virus to do it. Over and over again, when Trump has succeeded politically by saying things that are transparently untrue, we have been told that we'll never understand him politically if we are hung up on facts, because we need to "take him seriously, but not literally." I think that advice applies very neatly to this case. His travel ban was seriously meant as a gesture of resistance against a serious threat of disease from China, but the threat was not literally the coronavirus, as his subsequent rhetoric showed. Having a travel ban against foreigners arriving from China felt good and safe for his supporters regardless of the literal medical danger posed by a literal virus. "Seriously, but not literally" means that Trump could support a covid travel ban without believing that covid was a real threat. As usual, his target audience understood instantly, while the rest of us once again took months to figure out that Trump might not even have a literal opinion.

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